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Routine Practices _Recommended to review_ - University of Manitoba by gjjur4356

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									A set of infection control
precautions & practices used for
all patient care regardless of their
presumed infection status or
diagnosis
To prevent the transmission of organisms
from contact with blood, body fluids and
moist body substances with non-intact skin
or mucous membranes
• Hand Hygiene
• Personal Protective Equipment (PPE)
(gloves, gowns, masks, eye protection,
face protection)
•Accommodation
•Equipment
•Environmental Controls
•Sharps
•Linen
•Waste
•Specimen Collection
•Visitors Guidelines
•Education for Healthcare Workers,
Patients/Residents/Clients and Visitors
•Post Mortem Care
  Routinely treat all patients/residents/clients as if they are
                           infectious



Use Routine Practices for everyone!
              Infectious
                Agent

Susceptible                  Reservoirs
   host



Portal of                    Portal of
 Entry                         exit
                Means of
              transmission
•Infectious Agent:
   •A microorganism with the ability to cause an
   infectious disease
   •Infectious agents are bacteria, viruses, fungi and
   parasites
•Reservoirs:
   •A place within which microorganisms can thrive and
   reproduce
   •Example: Human beings, animals, water
•Portal of Exit:
   •A place of exit providing a way for a
   microorganism to leave the reservoir
   •Example: Microorganisms may leave the reservoir
   through the nose or mouth when someone sneezes
   or coughs
•Means of Transmission:
  •Route or method of transfer by which the
  infectious microorganism moves or is carried from
  one place to another to reach their new host
•Contact:
   •Direct
   •Indirect
   •Droplet
•Airborne
•Common Vehicle
•Vector
•Portal of Entry:
   •Means by which the infectious microorganism
   gains entry into the new host
   •Example: ingestion, breathing, skin puncture
•Susceptible Host:
   •A person who cannot resist a microorganism
   invading the body, multiplying and resulting in
   infection
• Direct physical contact
  between an infected or
  colonized individual and
  susceptible host (e.g.,
  Scabies)
• Indirect contact involves
  passive transfer via
  intermediate object to
  susceptible host (e.g.,
  contaminated equipment,
  hands of HCWs)
• Example: C.Difficile
• Large droplets > 5 um
  propelled from respiratory
  tract, coughing, sneezing
  suctioning or bronchoscopy,
  a short distance < 1 meter to
  nasal or oral mucosa of a
  new host
• Droplets don’t remain
  suspended in air
• Example: N. Meningitidis
• Dissemination of
  microorganisms by
  aerosolization
• Organisms suspended
  in air in droplet nuclei
  particles < 5 um
• Can be widely dispersed
  by air currents
• Example: Tuberculosis
•Common Vehicle:
   •Contaminated vehicle (water/food)
      •Salmonella
•Vector:
   •Non human that transmits infection
      •West Nile
Hand hygiene is the
single most effective
way to prevent infection
•Artificial fingernails, gel nails or extenders should not
be worn
•Natural nail tips should not be longer than 0.635 cm
(1/4 inch) long
•Nail polish should be removed when chipped
•Avoid wearing hand jewellery
•Hand Lotions:
   •Minimize skin irritation that can occur with
   frequent hand hygiene
   •Select lotions compatible with products and
   gloves used
•Dispensers:
   •Do not “top up” partially empty containers
   •Hand lotion bottles should not be used
When to Perform Hand Hygiene

Before:
-Direct, hands-on care with a patient, resident,
or client
-Performing invasive procedures.
-Handling dressings or touching open wounds.
-Preparing, handling, serving, or eating food.
-Feeding a patient.
-Shifts and breaks.
Between:
-Procedures on the same patient where soiling of hands
is likely, to avoid cross contamination.

After:
-Contact with blood, body fluids, non-intact skin,
and/or mucous membranes.
-Contact with items known or considered to be
contaminated.
-Removal of gloves.
-Personal use of toilet or wiping nose.
-Shifts & breaks.
•Must contain a minimum of 60% alcohol
•Use in all clinical situations, except when hands are
visibly soiled
•Use as an alternative to plain or antimicrobial soap
except when hands are visibly soiled
•Apply 2-3 mls of product to the palm of
one hand
•Rub hands together, covering all hand
surfaces, including fingernails, web
spaces, thumbs & palms.
•Ensure hands are dry before performing
another task (dries within 15-20
seconds).
NB: Alcohol products are flammable.
Plain Soap (Non-antimicrobial)
• For routine hand washing.
• Hands must be washed with soap &
water when hands are visibly soiled
with blood, body fluids, secretions,
excretions, and exudates from wounds.
•Antimicrobial Soap:
   •Before contact with invasive devices
   •Before performing any invasive procedure
   • Before contact with immunosuppressed patients,
   residents or clients
   •Before/after contact with patients, residents or
   clients on infection control precautions/isolation
• Wet hands under warm running water.
• Apply soap and distribute over hands.
• Rub hands together vigorously for 10-15 seconds to
create a good lather.
• Using friction, cover all hand surfaces including
fingernails, web spaces, thumbs and palms.
• Rinse under warm running water.
• Dry hands gently and thoroughly with a
disposable towel.
• Turn off faucet using a clean disposable towel.
• NB: Faucets are dirty!
           Assessment of Risk
The selection of gowns, gloves, masks and/or
face protection should include consideration of
the following:
   •Probability of exposure to blood and/or body
   fluids
   •Amount of blood and/or body fluids likely
   to be encountered
   •Probable route of transmission
                      Gloves


•Additional measure to, not a
substitute for hand hygiene
•Clean, non-sterile gloves of
appropriate size should be worn
•Single-use disposable gloves
should never be reused or
washed
                    Gloves

•Worn for contact with blood, body fluids, secretions
and excretions, mucous membranes, draining
wounds, or non-intact skin
•Worn for handling items visibly soiled with blood,
body fluids, secretions or excretions
•Worn when the HCW has open sores of his/her
hands
                    Gloves
•Put on directly before contact with patient, resident
or client or just before task/procedure requiring
gloves
•Change gloves between:
   •Care activities/procedures with the same patient,
   resident or client
   •After contact with materials that may contain
   high concentrations of microorganisms
                   Gloves

•Gloves should be long enough to fit over the cuff of
a gown
•Should be removed prior to leaving the patient’s or
resident’s room
•Hand hygiene must be performed following glove
removal
  Gowns

•Routine gown use is not
recommended
•Used to protect uncovered skin and
prevent soiling of clothing during
procedures/ care activities likely to
generate splashes or sprays of blood,
body fluids, secretions or excretions
                    Gowns

•Remove gown when task complete, when leaving the
room or when gown is heavily soiled/wet
•Gowns are single-use:
   •Disposable gowns are discarded
   •Cloth gowns are laundered after use
•Perform hand hygiene after removing gown
Masks

•Surgical/procedure masks
protect the mucous membranes
of the nose and mouth during
procedures likely to generate
splashes/sprays of blood, body
fluids, secretions or excretions
•Should be worn within 1 meter
(3 ft) of a coughing patient,
resident or client
                Masks


•Discard masks which are crushed, wet, have
dangled around the neck or have become
contaminated with patient secretions
•Perform hand hygiene following mask removal
                   Eye Protection
•Used to protect mucous membranes of eyes during
procedures/ care activities that are likely to generate
splashes, sprays or aerosols of blood, body fluids,
secretions or excretions
•Eye protection must fit over prescription glasses
•Reusable eye protection must be cleaned
•Perform hand hygiene following removal
                   Face Protection
•Used to protect the mucous membranes of the eyes, nose
and mouth during procedures/care activities that are
likely to generate splashes, sprays or aerosols of blood,
body fluids, secretions or excretions
•Face protection must fit over prescription glasses
•Face protection shall be of appropriate size-large enough
to protect mucous membranes of the face
             Respiratory Etiquette


Simple measures individuals can utilize to minimize the
spread of respiratory organisms
•Cover your cough
•Cover your mouth and nose with a tissue when you
cough or sneeze OR cough or sneeze into your upper
sleeve, not your hands
             Respiratory Etiquette

•Put your used tissue in the waste basket
•You may be asked to put on a surgical mask to
protect others
•Clean your hands after coughing or sneezing
•Wash with soap and water OR clean with alcohol-
based hand rub
Donning:
•Perform Hand Hygiene
•Put on long sleeve gown with opening of gown at
back
•Tie neck and waist ties
•Apply mask/respirator, seal check (if N95) to
ensure correct fit, reapply glasses
•Apply protective eyewear if appropriate
•Apply gloves, pulling gloves up over cuff of gown
Removing:
•Prior to Exiting Room or Area
   •Remove gloves using “glove to glove, skin to
   skin” technique, Discard
   •Perform Hand Hygiene
   •Untie neck ties first, then waist ties on the gown
   •Place fingers of one hand under the opposite cuff
   and pull cuff over hand
Removing:
•Prior to Exiting Room or Area
   •Using the gown covered hand, pull the gown
   down over the other hand
   •Pull the gown down off the arms, being
   careful that the hands do not touch the
   outside of the gown
Removing:
•Prior to Exiting Room or Area
   •Hold the gown away from your uniform and
   roll it up with the contaminated side inside in a
   away that minimizes air disturbance. Dispose
   into garbage or laundry hamper
   •Perform Hand Hygiene/Use paper towel to
   open door
Removing:
•Immediately After Exiting Room or Area
  •Remove eye protection/face shield if worn
  •Remove mask/respirator according to
  manufacturer’s instructions
  •Take care to prevent self contamination
  •Discard into garbage
  •Perform hand hygiene
•Single rooms not required for routine care
•Single rooms with dedicated bathroom facilities
for acute care when:
   •Patients soil their environment
   •Patients have inadequate hygiene
•Dedicate equipment for
individuals on infection
precautions or isolation
•Establish and monitor
regular cleaning schedules
with assignment of
responsibility and
accountability
•Clean and reprocess reusable equipment between
patients/residents/clients
•Reprocessing of a specific item depends upon:
   •Intended use of an item
   •Risk of infection to the patient, resident or
   client
   •Amount of soil present
•Visibly soiled equipment must be cleaned
immediately
•Handle soiled items in a manner that prevents
exposure of skin, mucous membranes and
contamination of clothing and environment
•Staff responsible for cleaning contaminated
equipment must wear appropriate PPE and be
properly trained
•Hand hygiene must be performed after
having contact with soiled equipment
•All horizontal and frequently touched
surfaces should be cleaned daily and
more often if soiled
•Spills of blood and body fluids must be
cleaned with a disinfectant immediately
•Disposable dishware, utensils and
dietary trays are not required
•Used needles/sharps must not be recapped
or manipulated by hand
•Handle with care to avoid injuries
•Discard in designated puncture resistant
containers located in the area where the
items were used
•Consider all soiled linen to be
potentially infectious
•Wear appropriate PPE to protect
skin, mucous membranes and
clothing from exposure to soiled
linen
•Bag at site of collection
•Double bag only if possibility of leakage
•Handle linen with a minimum of agitation
•Hand hygiene should be performed after
having contact with all soiled linen
• Wear appropriate PPE to protect
skin, mucous membranes and
clothing from exposure to waste
•Place in bag at point of origin
•Double bagging of waste is not
required
•Hand hygiene should be
performed after having contact
with waste
•All clinical specimens are considered potentially
infectious-appropriate PPE should be worn during
collection/handling
•All specimens must be placed in leak-proof containers
with secure lids to prevent leakage
•Avoid contamination of the outside of specimen
containers/laboratory requisitions
•Perform hand hygiene following specimen collection
•Visitors to hospitals and personal care homes
should be aware of and comply with infection
control practices including hand hygiene as
instructed by the healthcare worker (HCW)
•HCWs shall receive training on the
fundamentals of Routine Practices
•Patients/residents/clients shall be instructed
by the HCWs regarding infection prevention
and control practices
•Use PPE to prevent exposure to blood and other
body fluids
•Eye protection and masks are not routinely
required unless aerosols of blood and body fluids
are expected to be generated
•Remove all PPE immediately after use and follow
with hand hygiene
• Are infection control precautions and practices
required in addition to Routine Practices.
•Needed to interrupt transmission in the clinical
setting.
•Based on the means of transmission of the
infectious agent.
•Some microorganisms may be transmitted by more
than one route necessitating more than one type of
Additional Precautions.
•Single room with own bathroom preferred
•Door may be left open
•Gloves on entry into room/bedspace
•Gown if physical contact with
patient/environment is likely
•Equipment dedicated to the patient and then
decontaminate
•Example: C.Difficile, Antibiotic Resistant
Organisms (AROs)
•Single room with own bathroom preferred
•Door may remain open
•Surgical/procedure mask required for susceptible
people within 1 meter (3 ft) of patient/resident
•Equipment dedicated to the patient/resident and then
decontaminated
•No special ventilation of room required
•Example: Pertussis, Mumps, N.Meningitidis
•Door must remain closed at all times
•Special ventilation and air exchanges required
• Single room with own bathroom required
•N95 respirator, fit tested, for everyone entering
room
•Surgical/procedure mask for patient/resident during
transport
•Example: Tuberculosis
•Single room with own bathroom preferred
•Door may be left open
•Surgical/procedure mask required for susceptible
people within 1 meter (3 ft) of patient/resident
•Gloves on entry into room/bedspace
•Gown if physical contact with patient/resident or
their environment is likely
•Equipment dedicated to the patient/resident and
then decontaminated
•Example: RSV
•Single room with own bathroom required
•Door must remain closed at all times
•Special ventilation and air exchanges required
•N95 respirator, fit tested, for everyone entering the
room
•Gloves on entry to room or bedspace
•Gown if physical contact with patient/resident or
their environment is likely
•Equipment dedicated to the patient and then
decontaminated
•Example: Chickenpox
• Use disposable equipment whenever possible for
patients/residents on isolation-otherwise, use dedicated
equipment
•Ensure reusable equipment is cleaned before use on
another patient/resident
•Limit amount of supplies brought into isolation room
•Ensure correct signage is posted on the patient’s or
resident’s door
• All staff and visitors must comply with precautions.
•HCW must practice IP&C principles and be
competent with Routine Practices
•Recognize, understand and use signage to prevent
transmission of infection if Routine Practices are
indicated
•Maintain good personal hygiene and Respiratory
Etiquette
•Accept annual Influenza immunization and
maintain protection for other vaccine-preventable
infections such as Hepatitis B, Measles etc
•Consider the risks of infection transmission when
reporting for work while ill with common
communicable diseases, such as colds
•Eat and store food in designated places in the
workplace
•Act as a resource to co-workers about IP&C issues,
including communicating to co-workers about the
need to use PPE for contact with specific patients
•Advocate for patient/resident/client concerns about
IP&C

								
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